Current Practices in Rectal Cancer Surgery: A Survey of Thai Colorectal Surgeons

Objective: Surgical techniques and management of rectal cancer have been rapidly evolving. The aim of the present study was to assess current practices in rectal cancer surgery among Thai colorectal surgeons. Material and Method: Descriptive study was set between July and September 2008, a questionnaire was distributed to members (board-certified colorectal surgeons) of the Society of Colon and Rectal Surgeons Thailand regarding their current practices in rectal cancer including pre-operative management, surgical techniques, and postoperative surveillance protocol. Their perception of laparoscopic surgery was also emphasized. Results: Forty questionnaires were returned (80% response rate). Of the respondents, 45% worked in a university hospital. Surgeons were in broad agreement (>75 percent agree) on the routine preoperative use of carcinoembryonic antigen, CT or MRI of the pelvis for cancer staging, mechanical bowel preparation, pelvic drainage after colorectal anastomosis, and postoperative surveillance in patients with curative resection. Opinion was divided (<75 percent agreement) on the use of neoadjuvant therapy for locally advanced rectal cancer, lateral pelvic node dissection, rectal irrigation prior to bowel resection, air-testing after bowel anastomosis, the need of protective stoma, and duration of prophylactic antibiotics. Thirty-three surgeons (82.5%) believed that laparoscopic surgery achieved the same oncological outcomes of open surgery; however, only 40% of surgeons have experience in laparoscopic resection for rectal cancer. Conclusion: There is a considerable diversity of clinical practice for rectal cancer surgery, particularly in preoperative chemoradiation in locally advanced rectal cancer and to perform protective stoma after colorectal anastomosis. Meanwhile, postoperative surveillance protocol is quite uniform, and laparoscopic rectal surgery has gained attention among Thai colorectal surgeons.